Impact of double helical CT and three-dimensional CT arteriography on surgical planning for hepatic transplantation

Background: To assess the impact of preliver transplant double helical computed tomography (DHCT) and three-dimensional computed tomograhpy arteriography (3D-CTA) on surgical planning for hepatic transplantation. Methods: Vascular findings detected on DHCT/3D-CTAs of 80 patients were shown to the transplant surgeon in a blinded fashion. These findings included hepatic arterial anatomy, diameters of the major vessels that supplied the liver, celiac axis stenosis, splenic artery (SA) aneurysms, and portal vein thrombosis (PVT), The surgeon was asked to state the "planned" surgical approach for each case based on scan findings. These results were subsequently compared with what "actually" occurred at transplantation by review of surgical records. Results: Fifty-five patients had conventional and 25 patients had nonconventional hepatic arterial anatomy. Three patients had PVT, three patients had celiac axis stenosis, and three patients had SA aneurysms. Correlation between the "actual surgical technique" and the "planned surgical approach" was seen in 50/55 (91%) patients with conventional and in 23/25 (92%) patients with nonconventional anatomy. Five patients requiring aortohepatic interposition grafts for arterial anastomoses had either severe celiac axis stenoses or arterial inflow vessels that were 3 mm or smaller. Three patients with PVT underwent successful surgical resection of the thrombosed segment and standard PV anastomoses as planned. Patients with complete replacement of hepatic arterial supply to the superior mesenteric artery required alteration of the sequence of the vascular anastomoses. Patients with SA aneurysms had surgical ligation of the splenic artery. Conclusions: DHCT/3D-CTA provides noninvasive means to identify findings that have significant impact on surgical planning for hepatic transplantation including celiac axis stenosis, diameter of inflow arterial vessel less than or equal to 3 mm, complete replacement of hepatic arterial supply, PVT, and SA aneurysms.